Attachment 5_Financial Institution Reference Sheet_Undated_1 page.pdf

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Attached to
FTEV 16-1183, Renovate Office Space, 492 SOACS, Building 90322
Solicitation number
FA441720R0012
Issued by

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This document includes a Financial Institution Reference Sheet template and details of a federal contract opportunity for facility renovation services. The Financial Institution Reference Sheet is to be completed by contractors and sent to their financial institutions for verification of financial responsibility as part of the proposal evaluation process. The related federal contract opportunity is solicitation number FA441720R0012 to renovate existing dormitory space into new office areas and a command suite for the 492nd Special Operations Aircraft Squadron at Hurlburt Field, Florida. Work will include removing partitions and accessories supporting the dormitories, installing new interior partitions and office-type spaces, and providing new lighting, HVAC and electrical work.

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SOLICITATION NUMBER: FA441720R0012

FINANCIAL INSTITUTION REFERENCE SHEET

Instructions to Contractor: Include with your proposal a reference sheet for each financial institution that you have a business account with. This sheet may be sent to the banking institution/s in regards to a determination of contractor responsibility as part of the evaluation for award of this solicitation.

TO BE FILLED OUT BY CONTRACTOR:

COMPANY INFORMATION

Company Name: ________________________________________________________________

Point of Contact (POC) Name: ________________________________________________________________

POC Phone Number: ________________________________________________________________

INSTITUTION INFORMATION

Institution Name: ________________________________________________________________

POC Name: ________________________________________________________________

POC Title: ________________________________________________________________

POC Phone Number: ________________________________________________________________

POC Fax Number: ________________________________________________________________

POC Email: ________________________________________________________________

I give permission for the following information regarding my account/s at your institution to be released to representatives of the 1st Special Operations Contracting Squadron, Hurlburt Field, FL.

Name/Title Signature Date

DO NOT HAVE THIS SECTION FILLED OUT. IF YOUR FIRM IS SELECTED AS THE POTENTIAL

AWARDEE, THIS FORM WILL BE SENT TO YOUR BANKING INSTITUTION FOR COMPLETION.

TO BE FILLED OUT BY FINANCIAL INSTITUTION:

Please give amounts as a range – i.e. low four figures, mid six figures, etc.

Average monthly balance in checking: _________________________________________________________

Average monthly balance in savings: _________________________________________________________

Amount of any current loans: _________________________________________________________

Amount of any lines of credit: _________________________________________________________

Any late payments or NSF’s? _________________________________________________________

How long with this institution: _________________________________________________________

Credit rating with this institution: _________________________________________________________

I verify that the information provided above is current as of __________________.

Name/Title Signature Date

Attachment 5, Financial Institution Reference Sheet, Undated, 1 page

FINANCIAL INSTITUTION REFERENCE SHEET:
undefined:
Point of Contact POC Name 1:
Point of Contact POC Name 2:
1:
2:
3:
4:
5:
6:
NameTitle:
Date:
Please give amounts as a range ie low four figures mid six figures etc:
Average monthly balance in savings 1:
Average monthly balance in savings 2:
Average monthly balance in savings 3:
Average monthly balance in savings 4:
Average monthly balance in savings 5:
Average monthly balance in savings 6:
undefined_2:
NameTitle_2:
Date_2:

File details come from the government source that posted it. Updated .